Degenerative changes are common in the sternoclavicular joint (SCJ), but most cases are symptom free. Pain from an SCJ with CT- or MRI-verified osteoarthritis is the main indication for medial clavicle resection. Confirmation that pain origins from the SCJ is achieved by a pain-free interval following intra-articular injection of local anesthetics into the SCJ. The two standard arthroscopic portals are used, but they can be slightly modified if osteophytes block the way. After removal of the remains of the intraarticular disc, about 5 mm of the medial clavicular end is resected. Results are comparable to the outcome after open surgery. In 10% of cases, arthroscopic access is impossible due to osteophytes, and medial clavicle resection must be converted to an open procedure.